Obat yang melebarkan pupil (mydriatics) dan melumpuhkan akomodasi (cycloplegics) yang digunakan secara topikal dalam pemeriksaan mata dan prosedur tetes mata lainnya.
Mereka juga digunakan dalam pengelolaan kondisi peradangan mata untuk mengobati atau mencegah pembentukan adhesi antara lensa dan iris (lihat Uveitis, p.1515) dan strabismus (bawah).
Midriasis membutuhkan baik kelumpuhan otot-otot pupil pembatas, yang dapat dicapai dengan antimuscarinics, atau stimulasi otot dilator, seperti yang dihasilkan oleh simpatomimetik. Hasil Cycloplegia dari kelumpuhan otot-otot ciliary (antimuscarinics, tapi tidak simpatomimetik, memiliki efek ini). (martindale:1874)
Tropicamide (BAN, USAN, rINN)
Bistropamide; Ro-1-7683; Tropicamida; Tropicamidum; Tropikamid;
Tropikamidas; Tropikamidi. N-Ethyl-N-(4-pyridylmethyl)
tropamide; (2RS)-N-Ethyl-3-hydroxy-2-phenyl-N-(pyridin-4-
ylmethyl)propanamide.
Тропикамид
C17H20N2O2 = 284.4.
CAS — 1508-75-4.
ATC — S01FA06.
ATC Vet — QS01FA06.
NOTE. TRO is a code approved by the BP 2008 for use on single
unit doses of eye drops containing tropicamide where the individual
container may be too small to bear all the appropriate labelling
information.
Pharmacopoeias. In Chin., Eur. (see p.vii), Int., Jpn, and US.
Ph. Eur. 6.2 (Tropicamide). A white or almost white, crystalline
powder. M.p. 95° to 98°. Slightly soluble in water; freely soluble
in alcohol and in dichloromethane. Protect from light.
USP 31 (Tropicamide). A white or practically white crystalline
powder, odourless or having not more than a slight odour. M.p.
96° to 100°. Slightly soluble in water; freely soluble in chloroform
and in solutions of strong acids. Store in airtight containers.
Protect from light.
Adverse Effects, Treatment, and Precautions
As for Atropine Sulfate, p.1219.
◊ References.
1. Vuori M-L, et al. Systemic absorption and anticholinergic activity
of topically applied tropicamide. J Ocul Pharmacol 1994; 10:
431–7.
Glaucoma. The use of mydriatics is considered liable to provoke
an acute attack in patients with glaucoma or a tendency to
glaucoma; licensed product information generally contra-indicates
their use in such patients. However, a systematic review
concluded that in fact a history of open-angle glaucoma did not
predispose to acute angle closure under mydriasis, and that mydriasis
with tropicamide in particular appeared to be safe and
should be recommended in all patients when thorough retinal examination
was indicated.1 In contrast, the use of pilocarpine to
reverse mydriatics was potentially harmful.
1. Pandit RJ, Taylor R. Mydriasis and glaucoma: exploding the
myth. A systematic review. Diabet Med 2000; 17: 693–9.
Interactions
As for antimuscarinics in general (see Atropine Sulfate,
p.1220).
Uses and Administration
Tropicamide is a tertiary amine antimuscarinic with actions
similar to those of atropine (p.1219). It is used as
eye drops to produce mydriasis and cycloplegia
(p.1874). It has a more rapid onset and a shorter duration
of effect than atropine: mydriasis is produced
within 20 to 40 minutes of use and usually lasts for
about 6 hours; cycloplegia is maximal within about 30
minutes and is short-lasting, with complete recovery of
accommodation normally within 6 hours. Tropicamide
has been reported to be inadequate for cycloplegia in
children.
To produce mydriasis, a 0.5% solution is instilled 15
to 20 minutes before examination of the eye. To produce
cycloplegia a 1% solution is used and repeated
after 5 minutes; a further instillation may be necessary
to prolong the effect after 20 to 30 minutes.
Dementia. Tropicamide has been studied for use in the differential
diagnosis of Alzheimer’s disease (see Dementia, p.362).
Excessive pupil dilatation in response to tropicamide eye drops
occurred in patients with signs and symptoms of Alzheimer’s
disease.1 However, a double-blind placebo-controlled study2 in
similar patients and healthy subjects indicated that this was not a
reliable diagnostic test for Alzheimer’s disease.
1. Gómez-Tortosa E, et al. Pupil response to tropicamide in Alzheimer’s
disease and other neurodegenerative disorders. Acta Neurol
Scand 1996; 94: 104–9.
2. Graff-Radford NR, et al. Tropicamide eyedrops cannot be used
for reliable diagnosis of Alzheimer’s disease. Mayo Clin Proc
1997; 72: 495–504.
Preparations
BP 2008: Tropicamide Eye Drops;
USP 31: Tropicamide Ophthalmic Solution.
Proprietary Preparations (details are given in Part 3)
Arg.: Midriaticum†; Mydril; Austral.: Mydriacyl; Austria: Mydral; Mydriaticum;
Belg.: Mydriacyl; Tropicol; Braz.: Ciclomidrin; Mydriacyl; Tropinom;
Canad.: Diotrope†; Mydriacyl; Chile: Mydriacyl; Cz.: Mydriacyl†; Mydrum;
Denm.: Mydriacyl; Fr.: Mydriaticum; Ger.: Mydriaticum; Mydrum; Gr.:
Tropixal; Hong Kong: Mydriacyl; Mydriaticum†; Hung.: Mydrum; India:
Tmide; Tropico; Indon.: Midric; Irl.: Mydriacil; Israel: Mydramide; Ital.:
Tropimil; Visumidriatic; Malaysia: Mydriacyl; Mex.: Myriacyl; Norw.: Mydrian†;
NZ: Mydriacyl; Philipp.: Mydriacyl; Port.: Tropicil Top; Rus.: Mydriacyl
(Мидриацил); Mydrum (Мидрум); S.Afr.: Mydriacyl; Mydriaticum;
Singapore: Mydriacyl; Swed.: Mydriacyl; Switz.: Mydriaticum; Thai.: Mydriacyl;
Turk.: Tropamid; UK: Mydriacyl; USA: Mydral; Mydriacyl; Ocu-
Tropic; Opticyl; Tropicacyl; Venez.: Mydriacyl; Mydrox†.
Multi-ingredient: Arg.: Fotorretin; Sensu; Tropioftal F; Canad.: Diophenyl-
T†; Fr.: Mydriasert; Hong Kong: Mydrin-P; India: Itrop Plus; Tropico
Plus; Ital.: Visumidriatic Fenilefrina; Philipp.: Sanmyd-P; Port.: Mydriasert;
USA: Paremyd; Venez.: Dyfrin†; Fotorretin.
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